Is Botox Safe? 8 Botox Myths Explained

Botox is safe for most adults when a trained doctor injects a genuine product at the right dose. In trials covering 5,298 people, serious problems were about as common as with placebo: 1.6% against 1.3%. Bruising, headache or a droopy eyelid can happen, and they wear off. Fake products and untrained injectors add real danger.^1,2

8 Botox myths, and what the evidence says

Myth 1: Botox freezes your face

Botox relaxes the small muscles that crease your skin, and the rest of your face keeps moving. The American Academy of Dermatology says patients can keep their natural expressions.³ The dose and placement decide how natural you look, so your doctor watches how your face moves before planning each point.

Myth 2: Botox is only for wrinkles

The US FDA first approved it in 1989, and its label now lists nine medical uses, including chronic migraine, overactive bladder, heavy underarm sweating, muscle stiffness and eye muscle conditions.⁴ We offer Botox for excessive sweating. Jaw clenching isn’t on that list, though doctors do use it for this, so ask yours about masseter Botox.

Myth 3: Once you start, you can never stop

You can stop at any time. The effect lasts about 3 to 4 months, and then lines come back.^1,3 We found no study showing that they end up worse than they would have been. Repeat treatment doesn’t seem to wear out either: in a study of 50 people treated for an average of 15 years, researchers saw no treatment failure or shorter results.⁵

Myth 4: Botox is a poison, so it must be dangerous

It is made from a toxin, but it’s given in very small, purified amounts.³ In the pooled trials, 42.1% of people treated reported some side effect, against 35.8% on placebo, so much of that isn’t down to the drug itself.²

These side effects are the ones to expect, according to the product label:¹

• Frown lines: a droopy eyelid in about 3% of people.
• Crow’s feet: eyelid swelling in about 1%.
• Forehead lines: headache in about 9%, and a lowered brow in about 2%.

The label also warns that the effect can spread beyond the injection site, hours to weeks later. Trouble swallowing or breathing is an emergency.¹

Fake products are a real risk. In 2024 the US CDC investigated harmful reactions linked to counterfeit or mishandled injections: 17 people in 9 states, 13 of them hospitalised.⁶ Ask whether your injector is licensed and trained, and where the product comes from. If in doubt, don’t have the injection.⁶ At our clinics, doctors open a genuine, sealed vial for you alone.

Don’t have it if you’ve reacted to a botulinum toxin before or have an infection at the injection site.¹ It isn’t suitable in pregnancy or breastfeeding, or with a nerve-muscle condition such as myasthenia gravis, and you should mention any blood thinners or recent antibiotics.

Myth 5: Botox is only for women

Men have it too, mostly for the same forehead lines, frown lines and crow’s feet. Women did make up 82% of the people in the frown-line trials, and at 30 days 85% of women responded, against 59% of men.¹ Men’s facial muscles are usually stronger, so your doctor may use more units and keep your brow straighter.

Myth 6: Botox works straight away

The muscles begin to relax one to two days after the injections, and the effect builds through the first week.¹ Lines start to soften within three to five days, and the full result shows at about two weeks. Plan for this before a wedding or big event by having it two to three weeks ahead.

Myth 7: Botox and fillers are the same thing

They do different jobs. Botox relaxes muscles, so results build over days, and it treats upper-face lines. Fillers sit under the skin to add support and volume, with results straight away. Botox lasts about 3 to 4 months, and hyaluronic acid fillers about 9 to 12.⁷ Many people have both.

Myth 8: You have to start in your twenties

You don’t. Starting age depends on your skin and how your face moves. The study most often quoted followed one pair of identical twins: after 13 years, the twin treated regularly had no visible etched forehead or frown lines at rest, and her sister did.⁸ That is encouraging, though it’s only two people. If your lines only show when you move, ask your doctor whether you need it yet.

How do I reduce my risk of Botox side effects?

• Choose a doctor who assesses you first, and see the sealed vial.
• Tell your doctor about your medicines, pregnancy, and any past reactions.
• Follow the aftercare: don’t rub the area for 24 hours, and stay upright for 4 hours.
• Go back for your two-week review, so any unevenness can be checked.

Our Botox page covers what each area involves, the two brands we offer, and prices. Consultations for Botox are free at all 12 of our clinics, and you can ask for a female doctor. See clinics and what to expect for Botox in Lahore and Botox in Islamabad.

Medically reviewed by Dr Sadaf Saleem, Dermatologist, FCPS (Dermatology), PM&DC 62494-P; Dr Junaid Rabbani, Dermatologist, PM&DC 44510-S; and Dr Shegref Mushtaq, Dermatologist, FCPS (Dermatology), PM&DC 19827-N

1. DailyMed. BOTOX Cosmetic prescribing information.
2. Brin MF, et al. Safety and tolerability of onabotulinumtoxinA in the treatment of upper facial lines from global registration studies in 5298 participants. JAAD Int, 2024.
3. American Academy of Dermatology. Botulinum toxin therapy: FAQs.
4. DailyMed. BOTOX prescribing information.
5. Trindade de Almeida AR, et al. Long-term consecutive onabotulinumtoxinA injections for facial aesthetic treatment: a real-world study. Dermatol Surg, 2025.
6. US Centers for Disease Control and Prevention. Harmful reactions linked to counterfeit “Botox” or mishandled botulinum toxin injections. December 2024.
7. American Society of Plastic Surgeons. Taking the mystery out of Botox and dermal fillers. 2019.
8. Binder WJ. Long-term effects of botulinum toxin type A (Botox) on facial lines: a comparison in identical twins. Arch Facial Plast Surg, 2006.

Treatments in this article

Sessions, downtime and results for each, on its own page.

Botox InjectionsAppointment: 20–30 minutes · Downtime: None: back to work the same dayMasseter Botox for Jaw SlimmingAppointment: About 20 minutes · Downtime: None; back to work the same dayDermal FillersAppointment: About 30 minutes · Downtime: Swelling or bruises for a few days

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